tbuckley/cabot-search huggingface dataset:
Opportunities and challenges to implementing a coordinated social care network for patients with cancer: Perspectives of local community based organizations.
Authors: Sirad Hassan, Abigail Girgis, Emily Abramsohn, El Pinkerton, Cary Philip Gross
Journal: Journal of Clinical Oncology (2023)

e18647 Background: Interest is growing in identifying and addressing health related social needs for patients with cancer. One proposed approach is the creation of coordinated social care networks (CSCNs) to facilitate access to community-based resources and communication between community-based organizations (CBOs) serving patients with cancer. However, little is known about the perspectives of CBO leaders’ perspectives of addressing address health-related social needs or participating in CSCNs to serve patients with cancer. Methods: We conducted qualitative interviews of CBO leaders in New Haven, CT to assess perceived barriers to and facilitators for joining a CSCN. We also assessed leaders' awareness of how their services align with cancer care guidelines to address social and material needs of patients with cancer. CBOs were identified through a resource inventory of all New Haven-based CBOs. We employed qualitative content analysis and applied the Consolidated Framework for Implementation Research (CFIR) to classify emergent themes. Results: Respondents (N = 15) representing food pantries (n = 3), transportation agencies (n = 2), financial assistance organizations (n = 2), cancer-specific advocacy groups (n = 2), homeless shelters (n = 1), and general service organizations (n = 5) participated. We identified four themes: COVID-19 impact, referral challenges to other CBOs, challenges addressing client needs, and barriers and facilitators to joining a CSCN. The strongest theme was challenges addressing client needs which aligns with the CFIR domains of inner setting and individual characteristics. For instance, CBO leaders identified significant challenges with providing resources for patients with cancer due to lack of knowledge of client’s diagnosis. The theme of referral challenges to other CBOs, which aligns with the intervention CFIR domain, was exemplified by sentiments of limited funding and resources, lack of availability of information, and desire for client privacy. The impact of the COVID-19 pandemic was a theme relevant to both the individual and inner setting CFIR domains, particularly given its lasting effect on both the general community and patients with cancer utilizing CBOs at a higher rate, contributing to longer waitlists. Lastly, barriers to and facilitators of joining a CSCN largely align with the process CFIR domain. Respondents noted that lack of funding and resistance to adapting new technologies were barriers to implementing a CSCN in the New Haven area. Conclusions: While CSCNs may be a helpful mechanism to increase coordination between CBOs to help patients with cancer, critical barriers such as capacity, funding, and technology resistance may hinder implementation.
Barriers to diversity in cancer therapy: Uncovering disparities in knowledge and interpretation of genetic testing among African Americans, and their direct implications for access to mutation-based therapies.
Authors: Lena Lapidot, Michal Safran, Tzvia Bader, Avital Gaziel
Journal: Journal of Clinical Oncology (2023)

e18587 Background: African American cancer patients are disproportionately impacted by limited access to health education and resources, limiting their access to advanced care and clinical trials (CTs). In line, African Americans have the highest death rate and shortest survival of any racial/ethnic group in the US for most cancers. In this study we analyzed cancer patients’ knowledge of different parameters of their disease, including biomarker/mutational status knowledge which is vital for making informed treatment decisions. Methods: Leal (formerly, Trialjectory) is an AI-based platform that matches cancer patients to CTs based on a self reported medical profile. The profile includes parameters essential for CT matching including disease status, stage, biomarker/mutational status, treatment history, comorbidities and demographics. This study included a multi-racial sample cohort of 11,302 patients with advanced cancer who completed the questionnaire between 2019-2023. We characterized the general questionnaire completion rate and further focused on whether genetic testing was performed and on biomarker knowledge across varying clinical, demographic and racial/ethnic groups. Results: The general questionnaire completion rate was not affected by age, gender, or ethnic group. Genetic testing performance was associated with cancer types for which treatment guidelines recommend testing. There was no major difference in genetic testing performance between ethnic groups (Pearson’s Χ² = 0.05), with slightly lower rates in African Americans compared to other racial groups. A notable gap was found in the interpretation and reporting of test results across all races. Race and ethnic background had a significant impact on biomarker knowledge (Pearson’s Χ² &lt; 0.0001), with African Americans having a profoundly lower probability of knowing/reporting their mutation status compared to other races/ethnic groups. Clinical trials that require the presence of certain mutations for a match were ranked lower on the matched CT list or were not matched at all for patients who failed to report their biomarker data. Conclusions: African Americans are less likely to know or interpret/report their mutation status compared to other races or ethnic groups. This disparity was not influenced by the completion rate of the questionnaire, suggesting that ethnicity is not a hindrance to accessing technology. Our results highlight a significant gap in access to information and education particularly in regards to biomarker knowledge, which play a crucial role in obtaining the most effective treatment or accessing mutation-specific targeted therapy within or outside of a CT. Addressing these disparities is imperative to ensure that cancer patients can make informed treatment decisions.
METASNCore: A new tool for palliative whole brain radiotherapy (WBRT) assessment in the era of targeted therapies.
Authors: Pablo Flores Paco, Alicia Vargas, Maria Geraldina Guevara, Ignacio Lopera, Lucía Rodríguez Ruiz, López-Herrero María, Juan Adrián Camús, Javier López-González, Elizabeth Inga-Saavedra, Marina Montero, Isidoro Barneto, Maria Auxiliadora Gomez, Estela Ruiz, Marta Ruza, María Luz Tudela, Amalia Palacios, Juan De La Haba, Enrique Aranda
Journal: Journal of Clinical Oncology (2023)

e24154 Background: Palliative WBRT has been the main treatment for multiple brain metastases (BM). Recent studies report no benefit in survival or quality of life of WBRT compared to palliative supportive care in patients (pts) with poor prognosis. Several scores have been developed to support decision-making for selection of patients; despite this, the scales implemented so far do not consider the substantial impact of new developments in recent years. The purpose of this study was to develop and statistically validate a prognostic score in palliative pts with BMs who underwent WBRT. Methods: 239 pts with BM who received palliative WBRT between 2013-2022 in our center were analyzed retrospectively. Relevant clinicopathological features and their association with overall survival (OS) were measured using univariate and multivariate Cox regression models. The score was designed according to the value of the β coefficient of each variable with statistical significance (p &lt; 0.05) in the multivariate model. Extra 0.5 points were added to all variables with a statistical significance of p &lt; 0.001. Once the score was established, a comparison was performed according to Kaplan-Meier and the survival curves were analyzed with the log-rank test. Results: 149 pts (62.3%) were male and median age was 60 years. 139 (58,2%) were lung cancer (22,8% small cells), 35 (14,6%) breast cancer (53% luminal). 124 pts had ECOG 0-1 (52,1%) and 114 (47,9%) ECOG 2-3, 169 (70,7%) had extracranial disease and the most common symptom was headache (24,3%). All patients received 30Gys in 10 sessions. 37 pts (15,5%) had a specific target mutation and 15 (6,3%) received targeted therapy after WBRT. Median OS was 3,74 months (95% CI 3,28-4,20). After the multivariate analysis: ECOG, gastrointestinal (GI) or urothelial cancer, previous RT, protein C reactive (PCR), target drug treatment and chemotherapy after WBRT were shown to have independent prognostic value for the OS. Our score found 16% to 33% higher risk of the event taking place before per each point in the score. (HR (CI 95%): 1.243 (1.164 - 1.329). p &lt; 0.001) (table 1). We found that 48 pts were in group 0-4 points with mOS 6,89ms (CI 95% 3,18-10,62), 80 in group 4-7 points with mOS 4,01ms (CI 95% 3,40-4,62) and 90 pts in group &gt; 7 points with mOS 2,72ms (CI 95% 1,93-3,52). Conclusions: Some items in our cohort like ECOG, primary tumor site, PCR or post-WBRT systemic treatment (specially target treatment) are associated with OS and they could be useful in a score to select palliative pts to receive WBRT. More prospective and multicenter studies are necessary to corroborate our findings.[Table: see text]
Use of Myeloma Patient Outcome Scale (MyPOS) to gauge the effectiveness of palliative management in patients with multiple myeloma: Experience from a large tertiary academic center in India.
Authors: Astha Koolwal Kapoor, Seema Mishra, Sushma Bhatnagar, Lalit Kumar, Rakesh Garg, Nishkarsh Gupta, Vinod Kumar, Sachidanand JeeBharti
Journal: Journal of Clinical Oncology (2023)

e24137 Background: A diagnosis of Multiple Myeloma (MM) can carry significant physical, social, functional and emotional repercussions. There is a lack of data on Baseline Quality of Life (QOL) in patients with MM and effectiveness of palliative management in the Indian context, especially after the advent of newer chemo-immunotherapeutic agents and autologous stem cell transplant (ASCT). Myeloma Patient Outcome Scale (MyPOS) is the first questionnaire developed specific for MM patients. Objectives and Methods: To evaluate symptom burden and quality of life in MM patients admitted to the medical oncology ward. To assess change in quality of life and symptoms as well as analgesic requirements on telephonic follow up after one and three months from index admission. After institutional ethical clearance, MM inpatients were prospectively enrolled. Clinical and treatment related details were recorded. MyPOS questionnaire was administered as well as a detailed pain assessment using Brief Pain Inventory (BPI) was carried out at baseline, 1 and 3 months. Results: 82 out of 100 MM patients consented for recruitment (Mean age- 52 +/- 9yrs; Male- 55%). Mean duration of the disease since diagnosis was less than 1 year (0.86 years), with a mean International staging system (ISS) score of 2. Up to half (37/82, 45%) of the patients received ASCT in addition to chemotherapy. The baseline Global MyPOS Score was 58 +/- 8.8 while the mean Pain severity (MPS) and interference (MPI) scores were 25+/-8 and 43+/-10 respectively. The most painful region was the back. Only Tramadol was sufficient for a small minority (6/82, 7.4%), most required oral morphine. Most patents had significant interval improvement in their pain and QOL scores with a p less than 0.01 on follow-up (MyPOS at 1 month and 3 month were 81+/-6 and 78+/-5, MPS were 21+/-13 and 17+/-1.1, MPI were 38+/-2.2 and 37+/-2.1 respectively). Conclusions: Adequate pain management can significantly improve quality of life in MM patients. Use of standardized questionnaires such as MyPOS is a quintessential tool for the palliative specialist in order to gauge therapeutic efficacy.
Physical and emotional quality of life in children with B-acute lymphoblastic leukemia randomized to every 4- vs. 12-week vincristine/dexamethasone during maintenance: Children’s Oncology Group AALL0932.
Authors: Lyn M. Balsamo, John A Kairalla, Emily Hibbitts, Rozalyn L Rodwin, Meenakshi Devidas, Alexandra Dreyzin, Naomi J. Winick, William L. Carroll, Stephen Hunger, Elizabeth A. Raetz, Reuven J. Schore, Mignon L. Loh, Kirsten K. Ness, Anne L. Angiolillo, Nina S. Kadan-Lottick
Journal: Journal of Clinical Oncology (2023)

10025 Background: Children with B-acute lymphoblastic leukemia (B-ALL) undergo 2-3 years of treatment that impacts their quality of life. AALL0932 randomized reduction in vincristine and dexamethasone pulses (VCR/DEX every 4 weeks vs. every 12 weeks) during maintenance in the average-risk (AR) subset of NCI standard risk (SR) B-ALL. We longitudinally measured physical and emotional function overall and by treatment. Methods: SR AR B-ALL patients enrolled on AALL0932, aged ≥4 years, with English-speaking parents were evaluated at 5 timepoints (T1-T5: end consolidation, maintenance month 1, maintenance month 10, maintenance month 18 for boys/end of therapy for girls, end of therapy for boys). Parents completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0 and a survey of supportive services received. Age- and sex-matched z scores and proportion impaired ( &gt; 2 SD below normative mean; 2.5% expected in normative population) on the emotional and physical function subscales were measured longitudinally and compared by treatment with the Fisher’s exact test and repeated measures logistic regression. Results: Consent and data were obtained from 555 participants (mean/sd age = 6.0±1.6 years, 46.8% female). Among randomized participants with completed evaluations, 31.3% had impaired physical function at T1 decreasing to 12.5% at T4. Emotional function was impaired in 24.5% of patients at T1 decreasing to 9.8% at T4. Overall 34.9-43.8% received special education/accommodations at T1-T5; there was low use of other services (Table). In adjusted analysis, treatment group was not associated with physical or emotional function. T2 impairment predicted increased risk of impairment at T4 for physical (OR = 4.7, 95% CI 2.3-9.7, p &lt; 0.0001) and emotional (OR = 4.7, CI 2.3-9.5, p &lt; 0.0001) function. Conclusions: Impaired physical and emotional function were prevalent early in SR AR B-ALL therapy, improved by the end of therapy, but remained higher than norms. Outcomes did not vary with VCR/DEX frequency. Patients with early emotional and physical impairment are at elevated risk of later impairment. Clinical trial information: NCT01190930 . [Table: see text]
Use of medical cannabis in cancer-related symptons: A systematic review.
Authors: Claudia Vaz De Melo Sette, Jean Henri Schoueri, Daniel De Iracema Gomes Cubero, Auro Del Giglio
Journal: Journal of Clinical Oncology (2023)

e24170 Background: Medical cannabis’ (MC) use is increasing due to its alleged potencial effects amongst various diseases. In this sense, there are many papers trying to demonstrate its benefits in cancer-related symptoms (CRS). However, few randomised controlled trials (RCT) were done to date. This systematic review (SR) aimed to evaluate the eficacy of MC in CRS. Methods: We performed a SR acordding to PRISMA guidelines based on PUBMED, EMBASE, LILACS and WEBScience platforms seaching for RCTs using the following terms: medical cannabis OR cannabinoids OR dronabinol OR tetrahydrocannabinol OR AND nausea OR vomiting OR chemotherapy OR cancer OR pain OR cachexia OR anorexia. We included trials from January 2010 to January 2023 that evaluated the association between MC and CRS. Results: We found 2097 abstracts, of which 304 were RCTs. After excluding the ones that did not meet the inclusion criteria, repeated articles and non-published trials, we ended up with 9 papers. Most of these studies used oral sprays combination of CBD/THC and the results are heterogeneous as displayed in table 1. Conclusions: MC may have a potencial effect in CRS, however more RCTs are needed for current literature presentes low quality evidence for its use. Up to now, there is no clear data to encourage its use.[Table: see text]
Effect of colorectal cancer screening on 1-year mortality and medical costs: Real-world evidence from the largest commercial medical claims database in the US.
Authors: Chi Mai Nguyen, Jing Su
Journal: Journal of Clinical Oncology (2023)

10579 Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States with increasing trends in both mortality and incidence in individuals under age 50. Whether CRC screening reduces mortality recently becomes controversial in some observational studies due to a lack of data and a possibility of screenings confounded with social determinants of health (SDoH) and patient characteristics that were not properly addressed. Methods: We used the Optum’s de-identified Clinformatics Data Mart Database that provides information of healthcare plan, major SDoH, the CRC diagnosis, treatments, medical service and prescription charges, and survival data since 2007 for over 75 million patients to re-examine benefits of CRC screenings. Our CRC study cohort (N=99,704) included persons first diagnosed with CRC between 2010 – 2020, with 3-year pre-diagnosis continuing insurance coverage to identify pre-diagnosis screening, and 1-year follow-up to identify death and associated costs. Primary outcomes are 1-year mortality, the post-diagnosis medical and prescription cost increments, and health plan change after CRC diagnosis. Augmented inverse probability weighting (AIPW) models were employed to estimate the benefits of CRC screening, adjusting the probabilities of pre-diagnosis screenings due to insurance cover types (commercial/employer, Medicare advantage, and dual Medicare-Medicaid or low-income subsidy (LIS) covers), and healthcare plans (pre-paid, only-in-network, pay-less in-network, and fee-for-service plans), ages, sex, race, residential states, and calendar year. Results: In the study cohort, 37.8% have pre-diagnosis screening records, 18% died within 1 year. Women, persons under age 45, and persons with dual covers were more present in the non-screening group than the screening one. CRC screening was associated with a significant reduction of one-year mortality after adjusting for age, sex, race, health plans, and other factors (death rates in the non-screening group vs the screening one were 23% vs 12%, adjusted OR = 0.57, 95%CI = 0.55 - 0.59). Persons with no screening records experienced higher one-year medical cost increases than those who had pre-diagnosis screenings (17.8% vs 14.8%). No significant difference in health plan changes and/or disruption among the two groups was obvious for persons having either dual- or commercial-cover beneficiaries, yet the screenings slightly induced more these plan changes in the Medicare advantage beneficiaries (OR = 1.06, 95%CI = 1.01 - 1.11). Conclusions: The real-world evidence from the US largest medical claims database suggested that, after adjusting for the screening probability due to healthcare plans and other confounders, CRC screening dramatically reduced one-year death risk, and slightly eased the 1-year financial burdens after CRC diagnosis.
Real-world outcomes of first-line immune checkpoint inhibitors with or without chemotherapy in <i>KRAS </i>G12C altered NSCLC according to PD-L1 status.
Authors: Charu Aggarwal, Lamisa Parkar, Iker Huerga, Kate Sasser, Halla Nimeiri, Beata Korytowsky, Jyoti D. Patel
Journal: Journal of Clinical Oncology (2023)

9136 Background: There is a considerable debate whether treatment approaches should be tailored in advanced KRAS G12C-mutated NSCLC. Increasing evidence suggests that KRAS G12C-mutated NSCLC is associated with genomic heterogeneity that may impact clinical outcomes. Herein, we report a multimodal, real world outcomes analysis of 1L patients with advanced KRAS G12C-mutated NSCLC stratified by treatment type and PD-L1 status. Methods: Deidentified multimodal real-world data (RWD) of 1576 advanced, 1L NSCLC patients across the US were retrospectively analyzed from the Tempus database. Selection criteria included: Tempus xT targeted NGS, known PD-L1 status, absence of EGFR, ALK and ROS1 mutations, and treatment with chemotherapy (CT) + pembrolizumab (P), or P only. Patients were stratified by the presence or absence (wt) of KRAS G12C alterations. Median OS (mOS) was estimated using Kaplan-Meier methods. Subgroup analyses were performed using Cox model stratified by KRAS G12C status, PD-L1 status, and pathogenic alterations of STK11 and KEAP1. Results: In this study, two cohorts were assessed, KRAS G12C (n = 201) and KRAS G12C wt (n = 1375). Characteristics and demographics were balanced between both cohorts. Among TPS &lt; 50 patients treated with CT + P, KRAS G12C (n = 109, 54%) had a mOS of 11.64 months (m) versus 16.81m (HR = 1.32, p = 0.06) for KRAS G12C wt (n = 864, 62.8%). Among TPS &lt; 1 patients treated with CT + P, KRAS G12C (n = 46, 22%) had a mOS of 11.18 m versus 16.44 m (HR = 1.67, p = 0.01) for KRAS G12C wt (n = 489, 35%). Among TPS ≥50 patients treated with P only, KRAS G12C (n = 45, 22.3%) had a mOS of 30.03m compared to 25.03m (HR = 0.94, p = 0.83) in KRAS G12Cwt (n = 236,17.1%). TPS &lt; 50 subgroup was enriched for select co-mutations with KRAS G12C ( STK11, 24.5%; KEAP1, 10.7%) vs. TPS ≥50 ( STK11, 3.8%; KEAP1, 5.1%). When evaluating the impact of co-mutations in the KRAS G12C with TPS &lt; 50, STK11 (n = 30) mOS was 10.59m (HR = 1.01, p = 0.81) and KEAP1 (n = 13) mOS was 7.63m (HR = 2.14, p = 0.03). Conclusions: This largest RWD analysis to date demonstrates that 1L KRAS G12C NSCLC patients with TPS &lt; 1% and &lt; 50% receiving standard CT + P have the shortest survival among all evaluated sub-groups. Novel KRAS G12C targeted combination therapies in development for this patient population may offer the promise of better outcomes. [Table: see text]